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Here are some innovative ways EHR vendors are working to expand interoperability for providers and payers
The torch is being passed. And it’s burning brighter than ever.
From the instant that the American Recovery and Reinvestment Act was penned into law back in 2009, the federal government has advocated for nationwide health information exchange. Some of its tactical efforts have been rather literal, such as setting up state health information exchanges (HIEs), while others have focused on putting the pieces in place to enable exchange to occur through technical standards and policy guidance.
Up until 2012, the government drove information exchange of its own volition (and taxpayer dollars), setting the vision and pushing forward the interoperability mandate onto the industry through programs such as meaningful use, the EHR certification program, and the Affordable Care Act.
The results have been tangible: In 2013, almost 78 percent of office-based physicians reported they adopted some type of EHR system, according to the Department of Health and Human Services. During 2014, 76% of hospitals exchanged at least some type of data outside their organization, compared with 62% the year before, according to the American Hospital Association's annual hospital survey.
But over the last three years, the private sector has stepped into the limelight. Vendors and providers have taken the reins on operationalizing the exchange of data, even while the government continues to express its vision through such mechanisms as the Office of the National Coordinator's (ONC's) “Shared Nationwide Interoperability Roadmap.”
Five private sector initiatives in particular are accelerating the reality of interoperability, discussed here in chronological order:
1. Hub-to-hub exchange. The eHealth exchange is the oldest of these initiatives, having formed in 2006 as a Federal-led effort known as the Nationwide Health Information Network Exchange. In 2012, the eHealth Exchange was reformed as a public-private effort under the non-profit entity “The Sequoia Project,” with a continued focus on enabling hub-to-hub exchange of data, especially between hubs set up by very large provider organizations and HIEs.
2. Push-based exchange. DirectTrust.org was formed in 2012 as a nonprofit to carry on the work deferred by the Direct Project initiated by the ONC. DirectTrust.org focuses on shared agreements and a uniform certification process that enables providers to exchange data through push-based protocols, much akin to secure e-mail.
3. Pull-based exchange embedded into providers' software. Launched in 2013, CommonWell Health Alliance is the first and only HIT vendor-driven interoperability initiative focused on building working infrastructure and services for person-centric health data exchange nationwide. Its members are health IT market share leaders and technology innovators for the acute, ambulatory, post-acute care, imaging, laboratory, pharmacy and other healthcare segments.
Since access to CommonWell services is built into member products, CommonWell promises to enable seamless record location and on-demand “pull” of clinical data across the spectrum of care providers, from large health systems to single-doctor offices, pharmacies and post-acute care settings. At press time, CommonWell was on track to enable more than 5,000 provider sites nationwide to be enrolled on its services in 2015.
4. Standards for discrete data exchange. In 2014, the Argonaut Project was founded by a handful of major health IT vendors and prestigious health systems. Argonaut is focused on defining the standards for the exchange of “discrete” data, which is in stark contrast to the current standards for health information exchange, which focus on “documents” of data. Argonaut will not build any specific infrastructure to enable the usage of these discrete data standards (known as Fast Healthcare Interoperability Resources, often abbreviated as FHIR and pronounced as “fire”). Rather, it is accelerating the official creation and publication of them through Health Level 7 (HL7),an accredited standards development organization, so FHIR can be broadly used by organizations across the healthcare industry. It is also developing standards for the access of FHIR data from the EHR.
5. Network-to-network connectivity. Last but not least, in 2014, The Sequoia Project launched a new, separate initiative called Carequality under the assumption that, at some point in the future, the industry will be composed of a number of separate networks that will need to connect with each other. As such, Carequality is creating the policy and trust frameworks to enable such intra-network exchange, led by health IT vendors and healthcare provider organizations.
This is truly an exciting time to be in health data exchange, and all of these initiatives present numerous possibilities for the future of the collective “health Internet”. Direct Project is focused on the ability to “push” secure e-mail-like messages. While eHealthExchange is trying to enable on-demand “pull” of data from large targeted data repositories, CommonWell is providing on-demand “pull” through a seamless person-centered service built into the software used across and along the care continuum. In their midst, the Argonaut Project is trying to define standards reusable by all of these networks, while Carequality is trying to set some parameters that will enable the networks of today and tomorrow to be able to interconnect.
At the end of the day, as the torch is passed from government to private sector, one thing is clear: The future has never looked brighter for the ultimate benefactors-the patients and providers-for whom the exchange of information will create greater likelihood of empowerment, safer care, more satisfaction, and improved health.
Jitin Asnaani, is the executive director of CommonWell Health Alliance